Intermediate-onset colorectal cancer: A clinical and familial boundary between both early and late-onset colorectal cancer

• Published in: PloS one 2019-05, Vol.14 (5), p.e0216472-e0216472
• Main Authors: Arriba, María, Sánchez, Carmen, Vivas, Alfredo, Nutu, O A, Rueda, Daniel, Tapial, Sandra, Rodríguez, Yolanda, Brandáriz, Lorena, García, Juan L, García-Olmo, Damián, Goel, Ajay, González-Sarmiento, Rogelio, Urioste, Miguel, Perea, José
• Format: Article
• Language: English
• Subjects: Adult; Age; Age of Onset; Aged; Biology and Life Sciences; Biomedical research; Cancer; Cancer research; Cellular biology; Colonic Neoplasms - genetics; Colonic Neoplasms - mortality; Colonic Neoplasms - pathology; Colorectal cancer; Colorectal carcinoma; Colorectal Neoplasms, Hereditary Nonpolyposis - genetics; Colorectal Neoplasms, Hereditary Nonpolyposis - mortality; Colorectal Neoplasms, Hereditary Nonpolyposis - pathology; Comparative literature; Comparative studies; Disease; Disease-Free Survival; Female; Gene expression; Hospitals; Humans; Male; Medical diagnosis; Medical prognosis; Medical research; Medicine; Medicine and Health Sciences; Microsatellite Instability; Middle Aged; Polyps; Signs and symptoms; Social Sciences; Stability; Surgery; Survival Rate; Tumors
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0216472

Comparative studies of colorectal cancer (CRC) according to the age of onset have found differences between early-onset CRC (EOCRC) and late-onset CRC (LOCRC). Using this as a starting point, we wished to determine whether intermediate-onset CRC (IOCRC) might also be considered as an independent group within CRC. We performed a retrospective comparative study of the clinicopathological and familial features, as well as of the symptoms and their duration, of a total of 272 subjects diagnosed with CRC classified into three groups according to the age-of-onset (98 EOCRC, 83 IOCRC and 91 LOCRC). The results show that from a clinicopathological point of view, IOCRC shared certain features with EOCRC (gender, prognosis), and with LOCRC (multiple primary CRCs), whereas it also had characteristics that were specific for IOCRC (mean number of associated polyps). A gradual progression was observed from EOCRC to LOCRC from a greater family aggregation to sporadic cases, in parallel with a change of Lynch Syndrome cases to the sporadic microsatellite instability pathway, with the IOCRC being a boundary group that is more related to EOCRC. With respect to symptoms, duration and correlation with stages, IOCRC appeared more similar to EOCRC. Clinically, IOCRC behaves as a transitional group between EOCRC and LOCRC, with features in common with both groups, but also with IOCRC-specific features. Excluding cases with familial cancer history, the awareness for EOCRC diagnosis should be extended to IOCRC.